The need for networking and the challenges posed by diversity within the vast Arab world are two of the issues that emerged prominently from the Boosting research for health in the new Arab world meeting in Bellagio, north Italy which ended on Friday (1 March).

No one doubts that much cooperation and coordination will be necessary in order to tackle the research for health demand, but it is honestly difficult to see how virtually failed states such as Somalia, economically advanced realities like the Gulf States, and the Maghreb and Mashriq countries with their variable income levels, can be brought together to put forward a unified vision for public health in the region.

Up to now, there has been very limited dialogue among these countries, and not only regarding research- or science-related issues (the overall value of trade exchange between Arab countries, for example, is low). However, those involved in the health research agenda are positive that diversity in the Arab world, if wisely used, can actually benefit the requested change, as delegates present at the Bellagio meeting told SciDev.Net.

“Diversity should be perceived as an important factor for complementarity instead of a reason for division,” said Ziad Abdel Samad, Executive Director of the Arab NGO Network for Development in Beirut, Lebanon. “There is the necessity to create processes at various levels that must include academia and research. I’m aware of many existing initiatives among different universities and research centers focusing on health from different countries of the region.”

Samer Jabbour, from the Faculty of Health Sciences of the AmericanUniversity of Beirut, Lebanon, said: “All countries have a stake in cooperation as it will promote development and contribute to stability and legitimacy. Regional cooperation based on solidarity is simply the right thing to do. But we need to push, and from the bottom up, for this to happen in light of a prior history of poor functioning of formal regional platforms for common work. This is the task ahead of us.”

The role of the Gulf States might play in the effort is a matter of particular importance, given both their economic prominence and the considerable resources some of them, notably Qatar, dedicate to R&D.

Hanan Abdul Rahim, at QatarUniversity in Doha, Qatar, said: “There is a great interest in the Gulf in developing R&D systems. For example, Qatar partners with well known international universities in specific fields, such as medicine, engineering, and computer science, and links to a number of international research initiatives.”

“At the same time, the Qatar National Research Fund presents an opportunity for research collaborations with all parts of the world. Regional and international collaborations are not mutually exclusive. One does not have to preclude the other,” said Rahim.

But some believe that, in order to lead the research-for-health revolution in the new Arab world, the Gulf States must genuinely believe in their spearheading function while seriously reconsidering their attitude towards neighbours and potential partners.

“Regarding the Gulf states, many in the region want to see them play a greater role in promoting health and development,” said Jabbour. “This is another subject for advocacy for those interested in promoting research for health and development.”

But Abdel Samad said that “Gulf countries are supporting other Arab and Islamic countries; they are even considered among the largest donors worldwide. However, most of their donations are dedicated to charity and faith based initiatives. Few of these donations are directed to fund development programs and research projects.”

There is a lack of structured and transparent process of selecting partners and programs, and the way support is channelled is often conditioned by subjective choices, which highly affects the impact of allocated funds, argued Abdel Samad.

“This is a source of frustration which is leading people in the Arab world to rather address foreign donors that have their own requirements and conditions,” said Abdel Samad. “The objective is to advocate the Arab donors in order to motivate them to change this perception, and to create a properly transparent system, participatory methodologies and efficient strategies for implementation.”

Working groups gathered to think on country-specific needs for health research system strengthening, focusing on three main aspects: regional strategy and plan of action, engaging partners and building networks, funding perspectives.

The fund-raising problem is of course a crucial one, so a large part of the broader discussion that followed was devoted to explore possible avenues to get potential donors and financing bodies involved. Since the all initiative of strengthening health research in the Arab world is brand new, and the group of people that is coordinating the effort met here for the first time, one should not be surprised to know that only vaguely shaped plans were brought to the table so far. However, good, solid common ground was found to build on by selecting shared pointers for future action.

First, delegates agreed on the need for coming out with a ‘Big Idea’ about boosting health research as a driver of improvement of public health, advancement of fairness of health and equity, and socio-economic development in the region.

This should be something that captures imagination of donors and funding bodies, while being amenable to be efficiently communicated and appealing to politicians and the lay public as well.

“Something exciting is needed, but I still don’t see it here. This is necessary not only, or primarily, to allure donors, but to have a sharp vision of the common goal to achieve,” said Ibrahim Daibes, from the Canada-based aid agency International Development Research Centre, confirming that work has to be done in this direction.

Another consultation, opened to a larger panel of researchers, policymakers and stakeholders, will be held in a 6-months time frame to develop the ‘Big Idea’ concept further.

It was also noted that for the change to become structural and to impact substantially on health and related societal issues, donors will not be enough, but rather national governments need to be convinced to allocate appropriate resources to R&D in the health sector in their budget over a long period of time.

This – in a region where health and R&D expenditure is (with a few exceptions) relatively low (but that, on the other side, boasts the highest ratio of military expenditures as a percentage of GDP in the world) – is not going to be easy, as those around the table here in Bellagio are well aware.

Certainly, a carefully planned communication strategy will be key to the project, both to persuade international funding agencies to take the risk of investing in research in countries in conflict and transition and to raise advocacy at the national and regional level. “We have to speak clear, so to be sure that people don’t think we are asking for money just to fund our own research or academic institutions,” said Hoda Rashad, from the American University in Cairo, Egypt.

Future work needed to develop efficient health research systems in Arab countries can find a good starting point in previous experiences from other regions of the world. This is the main take-home message of the talk by Francisco Becerra, COHRED, staged today at the Boosting research for health in the new Arab world meeting in Bellagio, north Italy.

“COHRED aims to make an essential contribution to improve health, equity and development around the world. While there are many ways to do so, we focus on research and innovation – by and for low- and middle income-countries and populations,” said Becerra. “Our focus is on the systems needed for research and innovation for health. We believe that strong systems produce more and better research and innovation, with a greater relevance to the country and its population.”

Group at work at the Rockefeller Foundation Bellagio Center

Becerra presented COHRED work in Africa and Latin America, often performed in close collaboration with key regional partners, such as the New Partnership for African Development Agency (NEPAD) and the Pan-American Health Organisation (PAHO/WHO). In Latin America and the Caribbean, COHRED has developed regional and country based activities. Most notable is the work with Paraguay, which led to a presidential decree on research and innovation for health; and the collaboration with Uruguay on the establishment of a financial mechanism for research for health.

“A key aspect of COHRED’s work is to facilitate exchange and interaction among countries in a region. We strongly believe in this exchange with peers to stimulate research and innovation development,” Becerra said. “Regional meetings were therefore organised in Latin America in the recent past, and a knowledge exchange workshop for the African countries was organised in 2012 in Tanzania.”

Each country has its own peculiarities and needs specifically tailored solutions, experience shows. Also, countries are called to invest in their own systems, and to strengthen research and innovation capacity. If this does not happen and countries themselves are not interested, there is little that can be done through external aid.

“What is happening in the Arab world? Is there a similar interest in research and innovation and an assertiveness to take this development into own hands? What are the key political and regional players, and how can organisations such as COHRED make a meaningful contribution to research and innovation in the region?” asked Becerra. These are the questions the Bellagio meeting and subsequent discussions will aim to answer.

Brainstorming discussion is taking place at the ‘Boosting research for health in the new Arab world’ meeting in Bellagio, north Italy. The common view presented so far is that health is both a causative agent and an end-point of development, and that health research is a major driver of the entire process.

“Health is a societal good, not the exclusive interest of the Ministries of Health,” said COHRED Director Carel IJsselmuiden.

Iman Nuwayhid, from the Faculty of Health Science of the American University of Beirut, Lebanon, spoke about the role academic institutions can play in fostering the shaping of national health research strategies in Arab countries.

“Academic institutions are partly responsible for the status of research in the region,” said Nuwayhid. “On one hand, they have suffered from regional conflicts, lack of funding, a dearth of qualified researchers, lack of institutional collaboration, and restrictions on free scientific inquiry and access to information. On the other hand, these institutions have accepted the status quo and some have even served as a mouthpiece for the political regimes.”

However, exceptions exist, Nuwayhid added, and a few centers of excellence present models that are distinct but homegrown and worth scaling up in the region. “Building a regional network of such core academic institutions is no doubt a strict pre-requisite for any effort to support and shape research for health in the region,” Nuwayhid said.

According to the data presented by Nuwayhid, the Arab world is, at least on paper, well equipped with both public and private higher institutions (some 1,200) and universities (more than 400), with good geographic spread.

Quality, of course, differs greatly.

The Ranking Web of Universities (also known as Webometrics Ranking) in its last edition lists some 726 higher education institutions in the Arab world, with world rank position running from 420 (King Saud University, Saudi Arabia) down to 21,100!

As the UNESCO Science Report 2010 remarked, poorer countries like Egypt, Tunisia and Morocco are home to some of the oldest universities in the Arab world, and can be seen as regional leaders in terms of S&T human resources and scientific publications. On the other hand, institutions based in the Gulf States “have the material and financial resources to carry out R&D but lack the solid S&T and higher education systems to generate knowledge”.

But for academic institutions to be engaged as authoritative catalyzers of the transformation in the Arab world, they first have to rethink themselves. As an instructive example, Nuwahyd quoted the Kasr Al-Ainy School of Medicine of the Cairo University, inaugurated back in 1827, where teaching faculty is limited to graduates from the same institution.

“The uprisings in the Arab World have confirmed that people are ready for change. Academic institutions in this region are simultaneously the target of such a demand as well as the beacon of hope and change. It is a dilemma that we all, and especially donors and international organisations, need to face,” Nuwahyd said. “We have to invest heavily in academic institutions of this region. It is a leap of faith that we cannot afford missing. If entrusted, academic institutions will deliver.”

The Boosting research for health in the new Arab world meeting officially takes off today, in Bellagio, north Italy. Delegates from several Arab countries and representatives of the Council on Health Research for Development (COHRED) and of other institutions are swarming in, while sessions will begin early tomorrow.

Among the background papers distributed to participants in advance of the conference, several deal with the crucial aspect of the evaluation of the national health research systems (NHRS) of Arab countries. This is not trivial matter, as no comparable international indicator of the quantity/quality of health research exists.

An easily feasible – although admittedly limited – approach is to count medical research publications by researchers based in institutions in each country, as proposed by Martin McKee (London School of Hygiene & Tropical Medicine) and colleagues in a recent PLoS Medicine study. According to this indicator, the performance of Arab countries is (not surprisingly) a mixed bag, with countries such as Yemen and Somalia laying close to the bottom of the rank, and others, like Tunisia, doing fairly well, especially considering the available resources.

Other NHRS-mapping studies analysed the situation in the Arab word by using a more holistic approach, in particular trying to focus on the most important (but maybe most elusive to measure) outcome of health research: improved health of people, fair access to health care services, and reduced health inequities.

Using such a conceived method, COHRED-associated researchers have assessed the NHRS in most Arab countries, and recently published a study that completes the baseline information on health research systems in the region. In this last work five countries (Afghanistan, Iraq, Pakistan, Palestine and Syria) agreed to map their NHRS and collect information on research policies and regulations, governance and management mechanisms (including ethics review boards), and institutions that commission, produce and use research.

The day is coming. Tomorrow, 26 February, a meeting on ‘Boosting research for health in the new Arab world’ will begin in Bellagio, north Italy. Before formal discussion kicks off, we asked Hassen Ghannem, senior consultant to the Geneva-based Council on Health Research for Development (COHRED) and meeting organizer, about the background and objectives of the conference.

What is the current situation of health research in the Arab countries?

“Policymakers in the developed world understand that research, science and technology are vital components of economic growth and prosperity. But, in the Arab world, translating this realization into policies and actions backed by resource commitments has been a major challenge.

In particular, weaknesses of research for health in the Arab world are seen in three areas: low investment in research and development; weak national health research systems, with considerable fragmentation and little or no coordination at the national and international level; poor scientific production and impact, as a result of low investment and weak systems.”

In your personal opinion, what is to be done to change this situation? Is the Arab Spring going to have a significant impact on the status quo?

“This region is currently experiencing major historical changes with the aspiration to freedom, democracy and more equitable development. Research for health is essential to understanding the current and future projected health needs of the population and developing approaches and solutions that can contribute to health improvements.

Because research for health and national systems of research for health have been weak in the region, this time of change creates a historic opportunity to undertake key strategic actions in research and innovation, with particular focus on strengthening national systems of research for health leading to improvements in health and development. This could be done, among other things, by engaging policymakers and stakeholders to equip them with tools and skills needed for making informed decisions, and by hosting dialogues and consultative meetings to bring a range of stakeholders together to facilitate policy dialogues leading to more commitment to fund research in the region.”

What do you hope will come out of the Bellagio’s meeting?

“The overall goal is to end up with a strong call to action to strengthen system capacity for research and innovation for health in the Arab world, and to develop an effective communication strategy to disseminate and keep this alive until the regional conference that is planned for later this year or 2014.”

Ahmed Zewail was the star speaker here today. He is not just a Nobel prizewinner in chemistry but an intellectual at ease in both the Middle East and the West. So he took the opportunity to berate those journalists who represent the latter for the West’s negative perception of the Islamic world.

“Arabs are demonised,” he said, saying they are generally depicted as violent and anti-American. The Egyptians demonstrating “civility in their uprising” in Tahrir Square show this image is wrong, he said.

More relevant to science journalists, the common believe that Islam is in conflict with progress, is wrong, he said.

“There is nothing fundamental in Islam that is against science.”

And as for the “conflict of civilisations” theory that has gained currency, thanks to academics at Harvard University, United States, he said: “I don’t see any physics in such theories.

“The bottom line is that people want liberty and a good life to live.”